JAMA Clinical Guidelines Synopsis February 15, 2022
Diagnosis of Lyme Disease
David Pitrak, Cynthia T. Nguyen, Adam S. Cifu, et al
JAMA. 2022;327(7):676-677. doi:10.1001/jama.2022.0081
Guideline title Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease
Developers and funding source IDSA, AAN, and ACR
Release date November 30, 2020
Prior version 2010
Target population Adults and children with suspected Lyme disease
Major recommendations
- Asymptomatic patients should not be tested for Borrelia burgdorferi after a tick bite (strong recommendation; moderate quality of evidence [QOE]).
- In patients with early disease with 1 or more skin lesions typical of erythema migrans, no laboratory testing is necessary (strong recommendation; moderate QOE). If the lesion(s) are atypical, careful follow-up with acute serological testing for antibodies at presentation and convalescent testing at least 2 to 3 weeks later is indicated (weak recommendation; low QOE).
- When evaluating for possible Lyme neuroborreliosis, serum antibody testing is recommended instead of polymerase chain reaction (PCR) or culture of cerebrospinal fluid (CSF) or serum (strong recommendation; moderate QOE). If CSF testing is done, simultaneous antibody testing of CSF and serum should be done to determine the CSF:serum antibody index (strong recommendation; moderate QOE).
- Routine testing for Lyme disease is not recommended for patients with known neurologic conditions, cognitive decline, dementia, or psychiatric, behavioral, or developmental disorders (strong recommendation; low QOE).
- At-risk patients with acute myocarditis/pericarditis of unknown cause should have serum antibody testing (strong recommendation; low QOE).
- Serum antibody testing is recommended for possible Lyme arthritis (strong recommendation; moderate QOE).
